Surgical training, supervision, and service

Laissez-faire attitudes to surgical training and patient care are unsustainable

Charles Collins, Consultant surgeon

Taunton and Somerset Hospital, Taunton, Somerset TA1 5DA

Papers p 702

For too long the National Health Service has depended on trainees undertaking a significant proportion of unsupervised elective surgery and an even greater proportion of emergency surgery,1 a fact that was formally recognised in 1990 in the calculation of suitable workload figures for a general surgical team in a district hospital.2 The published evidence to support the extent of trainees‘ involvement in specific areas of surgical service is, however, sparse, although periodically it has caused concern.34 In this week's issue Aitken et al provide further evidence that a high proportion of colorectal surgery is still being done by trainees. This practice is unsustainable, and doctors and managers must organise to enable more work to done by consultants.

Aitken et al present an audit of colorectal surgery performed in 1990–4 in three parts of the United Kingdom—comprising about a fifth of the population. This shows that consultants supervised only a fifth of the resections performed by trainees and were present at less than two thirds of the total number of operations (p 5 Supervision was even lower in emergency cases, particularly …